Wednesday, February 14, 2007

Concierge Care: Is it the answer?

The "concierge," "boutique," or "patient-centered" model of medical practice is drawing a lot of attention these days. Doctors that are discontented with the way the medical system works are deciding to drop out of the insurance picture and repaint a kinder, more time-friendly scene for their patients with increased access (like giving out their own private cellphone number). In effect, from an individual perspective it is wonderful, but its critics challenge that it's going to aggravate the impending doctor shortage. But will it really?

In 2005, the Government Accountability Office reviewed this growing trend for concierge medicine. They decided at the time that there were not enough concierge docs to affect access to care, yet. If that is the case, I wonder what they will do. Will they make it illegal to practice this style of medicine? Will making it against the law not continue the trend of growing dissatisfaction and doctors leaving medicine, thus the path to a physician shortage?

Here's another question. If doctors choosing this practice model are happier overall, providing higher quality, more compassionate care, wouldn't that increase the number of physicians wanting to become primary care physicians, because of a renewed chance for job satisfaction in this specialty? After all, why are more and more residents choosing subspecialties? Is it because they love that aspect of medicine, or it is also because they know that it offers greater monetary rewards? Let's be honest, for as much as society would like to believe that people become doctors to help the greater good, doctors still have to live in the practical world of paying for their living and for their other dreams, which may include owning a home, having a family, being able to take quality vacations, or pursuing a hobby or outside passion. Doctors are no longer the unidimensional workers they once were. People have varied interests, and having quality of life is becoming ever more important for the coming generation of doctors.

The other argument against concierge care is that it creates a stratified healthcare system, providing the best care to those that can afford it. This is a tough one. How do you argue against that? Unfortunately, everything else in society is stratified. Not everyone gets to eat in the best restaurants, fly first class, own a large home, go on a yearly vacation.... the list goes on. Come on, our society is stratified by money. That is what capitalism is all about, because even the poorest can make it. Whereas in a communist system with universal everything, the poorest stay poor and the rich stay rich. Does this justify it? Hey, one's health is an investment. The same people that don't want to pay for it are out there buying ipods and xbox's and paying for plastic surgery. Where there's a will, there's a way. It's just that America's values are skewed. Government could provide low-income housing and further tax breaks so that the lower class and the lower middle class could afford their healthcare. The old model simply doesn't work, because healthcare dictated by those that are trying to not pay for it (i.e. insurance companies) just doesn't work.

So what should the emphasis be with patient-centered care? Well, make it a true patient- doctor alliance. Concentrate on preventive care to save the healthcare system money. Allow time to create a plan of action and educate patients on how to take good care of themselves.

Is concierge care the answer? In many ways it's a better model than what has developed in the current system. The current system thinks that doctors are some incredible superheroes able to take care of a multitude of problems in minimal time. This is simply not possible. Good care does NOT happen in a 5 minute visit. Even a 15 minute visit is pushing it for patients with multi-system problems. Concierge care brings reality back to medicine. Insurance companies have corporatized medicine beyond human capabilities. Concierge care is humanizing it again. I'm trying to find the answers, and concierge, patient-centered care is very attractive. Let's make the patient the boss again, and work for them, instead of the insurance companies.

And until I convert, I'm following the low-overhead micropractice model to make this process of building a practice from the ground up more palatable.

2 Comments:

Anonymous Bonnie said...

This is an interesting argument. I keep coming upon articles that suggest that acupuncturists stop offering 'boutique' medicine and start seeing multiple patients an hour to maximize the number of people who can be served and to offer this type of medicine to more patients. I have issues with how well you can serve people in that sort of setting.

It's interesting to read a medical doctor talk about bring his practice under control by going the OTHER direction... hmm...

8:44 PM EST  
Anonymous Julie Munro said...

Some who are against concierge care protest that it's not available to all. Not so. Not any more. Concierge medical care and concierge doctors are also available for those with lesser financial means. As long as they are prepared to go abroad for this care.

This is not a trivial notion. Healthcare has been moving beyond borders for centuries with travelers and pilgrims seeking cures in mineral waters and at holy grottoes. Now that physicians and specialists who train in American medical schools choose to return to their homes in the “second world” industrializing countries to build their practices and offer their services to anyone who comes, the healthcare paradigm for all of us shifts.

Today, we all have the opportunity to access some of the world’s most talented and skilled doctors at half or quarter or less of the cost of treatment in our home countries. With the help of experienced medical concierge and medical support agencies who are developing sophisticated “international patient management” services, personalized concierge care is available at modest cost.

Patients who travel abroad to access this care find that outside the US – or Canada or the UK et al – they don’t line up in queues, they don’t wait days or weeks for tests or results, and they can get expert, compassionate, hands-on personalized concierge care of the sort offered in expensive VIP suites in American hospitals.

4:45 AM EST  

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